Healthcare Provider Details

I. General information

NPI: 1720079866
Provider Name (Legal Business Name): CYNTHIA ALCOBA MAINS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 BOULEVARD NE SUITE 400
ATLANTA GA
30312-1200
US

IV. Provider business mailing address

315 BOULEVARD NE STE 400
ATLANTA GA
30312-1264
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4789
  • Fax: 404-265-3542
Mailing address:
  • Phone: 404-265-4789
  • Fax: 404-265-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN148280 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: